The feminization of medicine: does it matter?

Quebec now has more women (10,179) than men (10,134) practising medicine – a first in the province, and in Canada.

"The glass ceiling has been shattered," Dr. Charles Bernard, president of the Collège des médecins, said to La Presse.

Not quite. But there are a few cracks, 150 years or so in the making, beginning to show.

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The role of women in medicine has been a subject of debate and discussion, and marked by no small amount of struggle, since Emily Jennings Stowe became the first woman to practise medicine in Canada in 1867. (She did so without a licence.)

Her friend and collaborator, Jennie Kidd Trout, became the first woman licensed to practise medicine in the country in 1875. Both of them studied in the United States because Canada shut women out.

Dr. Stowe's daughter, Augusta Stowe-Gullen, became the first woman to graduate from medical school, at Victoria University in Toronto in 1883.

It was not until 1909 that the first woman surgeon was able to practise in Canada. Jennie Smillie Robertson had to do her residency in the United States because she was not allowed to do so in this country. She went on to help found Women's College Hospital in Toronto.

Despite these pioneers, progress was slow. By 1968, only 13 per cent of medical students were women. Today, it's 40.6 per cent of the physician work force nation-wide that is female. The Quebec data are an indication we're approaching a tipping point.

Women will soon be the dominant force in medicine across the country: 56 per cent of medical residents and 63 per cent of medical students in Canada are now women.

Not to mention that, in the aging physician work force – the average age 45.9 years for women and 52.4 years for men – more men are set to retire than women in the coming years.

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The big unanswered question is: Does the feminization of medicine matter? There is actually a lot more speculation than there is research on the issue.

When stories are published about the increasing number of female physicians, they tend to have a negative spin. It is widely assumed that female doctors work less and, as a result, the increasing female work force is routinely blamed for physician shortages.

Those claims need some demystifying.

What little evidence there is shows that all physicians are working less, particularly younger ones. While more female doctors opt for part-time work than their male counterparts, that doesn't mean they work less efficiently when on the job.

The push for more work-life balance may well be driven by women – who still bear a disproportionate share of child-rearing and household responsibilities – but it is not exclusive to them, nor is it a bad thing.

There are 84,063 physicians in Canada, which is more – in raw numbers and per capita – than there have ever been, so the suggestion that the increasing ranks of women are creating a shortage is a dubious claim.

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What is true is that the demographics of the population and the needs of patients are changing dramatically, and the profession and the health system have not adapted.

We do know from research that many female doctors work differently than men. They tend to spend more time with patients and place more emphasis on communication and team work.

The way we pay physicians – largely on a fee-for-service basis – means that they are punished financially for this patient-friendly approach.

It is not a coincidence that the medical specialties in which women are the most numerous – family medicine, pediatrics, psychiatry and geriatrics – all rank among the lowest-paying.

Female physicians are paid less than their male counterparts, even in salaried positions, and they are less likely to attain the most senior (and lucrative) positions in hospitals and academia.

Beyond the overt sexism, there is socialization and acculturation at play. For example, women are less likely to ask for pay raises, or to put their names forward for awards and prestigious positions.

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In other words, women don't toot their own horns the way men tend to do – and that is true even for women in medicine, who are among the most driven, smart and self-assured in society.

After 500 years of male domination in medicine, the numbers are changing, but attitudes are not keeping pace. There is no shortage of #MeToo moments among female practitioners.

Medicine is still largely an old boys club, especially in the upper echelons.

We're still a far cry from equality.

A Tuesday column on the feminization of medicine incorrectly suggested 40.6 per cent of Canadian medical students are female. In fact, that is the percentage of Canadian physicians.

Editor’s note: A Tuesday column on the feminization of medicine incorrectly suggested 40.6 per cent of Canadian medical students are female. In fact, that is the percentage of Canadian physicians.

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